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Perceptions of Australia's health care system

Posted 06/12/2010 by Rebecca de Boer

Perceptions of the health care system are difficult to measure and there is very little comprehensive information about how Australians perceive the heath care system. The Menzies Centre for Health Policy and the Nous group recently completed a survey (Menzies-Nous 2010 survey) on Australians' attitudes to the health care system. This is a repeat of the survey completed in 2008, on which the 2010 survey was based.

The survey found that, on average, Australians are satisfied with the health care system. Satisfaction was highest with services provided by pharmacists, followed by private hospitals and specialist doctors. There is a high amount of confidence that the health care system would provide safe and quality care in the event of serious illness. Some concerns were raised about affordability, but most were confident in their ability to access care (including appropriate medical technology and affordable drugs). Usage of the health care system (such as doctor visits) remained relatively constant from the previous survey but with a slight increase in hospital usage from the 2008 results.

The majority of respondents to the Menzies-Nous 2010 survey rated their personal health as either good or very good to excellent. Those suffering from financial stress were more likely to rate themselves as having poor health. This is consistent with the Catholic Health-NATSEM survey released earlier this year which demonstrated a relationship between poor self-reported health status and socioeconomic disadvantage.

Waiting times for general practice varied according to location, with the longest waiting times for appointments in areas outside of capital cities. The length of time increased if patients wanted to see their own doctor. Young people (18-24) usually were able to see a doctor on the same day, but were most likely to see different doctors or attend a different practice. This raises questions about continuity of care and suggest that electronic or portable health records would have a role in ensuring co-ordinated health care in these cases. The increased waiting times for areas outside of capital cities also highlights the maldistribution of the health workforce in Australia.

Although aged care was not the focus of the survey, some questions were included on aged care. This is the first time these questions have been included, so it will take some time before patterns emerge. Survey respondents considered access to aged care to be either fairly or very difficult. Many also considered it to be unaffordable. While the costs of providing residential aged care are high, there is some government assistance available, particularly to those on full pensions. The Government has recently signalled that it intends to reform the aged care sector during its second term. The aged care sector has long been campaigning for changes to the aged care sector, including removing the distinction between high and low care and increased user pays for those who have the capacity to pay. This has previously been canvassed by the Productivity Commission (PC) and aged care is the subject of a current PC inquiry.

This Menzies-Nous 2010 survey considered hospitals in the context of use of the health care system, as well as the proposed changes to hospital funding arrangements. It showed that more Australians had been patients in a hospital than the previous survey. This may be due to a number of factors, perhaps including increased government attention and additional funding to reduce elective surgery waiting times over the past two years. A more detailed survey of Australia’s hospitals has been released by the Australian Institute of Health and Welfare (AIHW). This survey notes that 610 000 patients were admitted into public hospitals from waiting lists in 2009-10. It also showed that rates of elective surgery were increasing, on average, by about two per cent per annum.

The Menzies-Nous 2010 survey also attempted to measure support for the Government’s health reforms. Two aspects of the reforms were measured. The first was local management of hospital services with increased federal funding. The second was support for nurse-led clinics. Both had high levels of support; and support fornurse-led clinics was highest in areas outside of capital cities and with younger people. The specific nature of the question means that it is not possible to infer whether there is broad support for the Government’s entire health reform package and the proposed restructuring of federal financial relations to fund health.

The findings of the Menzies-Nous 2010 survey provide an interesting insight into the perceptions held by Australians about the health care system. It highlights, once again, the relationship between wealth and health outcomes and that those suffering from financial stress are more likely to report poorer health. It also shows that physical location and age play a significant role in one’s satisfaction of the health care system. Older (65+) and younger (18-24) Australians were most likely to be satisfied with the health care system. Those living in capital cities are also likely to be satisfied with the health care system. For policy makers and governments attempting to reform the health care system, it appears that many of the factors influencing health outcomes and satisfaction with the health care system are outside the ‘health care system’ as it is traditionally understood and a multi-sectorial approach is required.